Tympanomastoidectomy

 Tympanomastoidectomy - surgery involving the complete or partial excision of the typanic membrane, also called tympanoplasty and mastoidectomy.

Tympanoplasty

Indications and pathophysiology

• Your eardrum, also called tympanic membrane may lead to infections if there is a hole.
• This can affect your hearing.
• You may also get a “cholesteatoma.” This is a cyst made up of trapped skin cells.
• The cyst can invade the inner ear, brain, or facial nerve. For this reason, a cholesteatoma must be completely removed.
• The ossicles may be eroded from repeated infections or from cholesteatoma.
• They may need to be replaced with a man-made part (called a prosthesis) when you have surgery. This may help you hear better.

Tympanoplasty and Mastoidectomy

Your doctor will make a cut (an incision) behind your ear or inside the ear canal. A small amount of tissue will be taken from the muscle above your ear. This is done through the same incision. You may also have a small skin graft removed from the back of your ear. The doctor may use cartilage from your ear canal to rebuild your eardrum. Then your ear will be sewn back in place. The doctor will pack your ear canal with a spongy material.

Attack triangle in mastoidectomies

Sameday surgery

You will go home the same day of surgery. You will need someone to drive you home. It is normal to feel a little dizzy for a few days after surgery. If the dizziness is very bad, call your doctor. It is normal to hear funny noises inside your ear for weeks to months after surgery.

Over-Under tympanoplasty

Post-Operative Instructions

Ear Surgery:

• 1. If you have a plastic cup ear dressing, remove it after 24 hours. You do not have to wear it any longer. You may replace the gauze in the cup with clean gauze and use it at night to sleep if your ear is more comfortable that way. Or you can throw it away.
• 2. When you remove the plastic cup dressing, take off the non-stick gauze that is over the incision behind your ear. Begin applying an antibiotic ointment such as Polysporin or Bacitracin to the incision 2 times a day. Do this for 4 days. Gently clean the incision with a mixture of ½ hydrogen peroxide and ½ water on a Q-tip to remove dried blood. The stitches will go away on their own.
• 3. After 3 days you can wash your hair and pat dry your incision. Keep water out of your ear canal until your postoperative appointment. You can best do this by placing a cotton ball in your ear canal, covering it with Vaseline, and removing it after bathing.
• 4. If you have a gauze ear dressing, cut it off when told to by your doctor.
• 5. After 24 hours, take out the cotton ball from your ear canal. Use the antibiotic drops the way your doctor told you to. Most often you will place 4-5 drops in your ear canal 2 times a day until you return for your postoperative visit. This will lessen your risk of infection. It will also keep the sponge packing in your ear canal wet. This will make it much easier to clean out at your next visit.
• 6. After 24 hours you can put in another cotton ball if your ear is draining. If you do not have drainage, you do not need to do this.
• 7. You may have some drainage and mild bleeding from your ear canal for the first few days after surgery. If you need to change more than 12 cotton balls in a 24 hour period because they are bloody, this is too much. You will need to be seen by your doctor.
• 8. Some of the packing that is placed in your ear canal may fall out after surgery. Sometimes it looks like a tiny wet sponge. Other times it looks like a tiny piece of meat. Do not worry about this. Do not try to put the packing back in.
• 9. Do not place anything in your ear canal. Do NOT insert a Q-tip into your ear canal.
• 10. Do not blow your nose for at least 2 weeks after surgery. You may gently wipe the front of your nose. Blowing the nose could dislodge your new eardrum.
• 11. Sneeze with your mouth open for 2 weeks. Pressure from a sneeze could dislodge your new eardrum.
• 12. If you wear eyeglasses, you can use them once the dressing is removed, but place a gauze pad or a Band-aid to keep the rims from irritating the incision.

Physical Activity

Do not do any heavy lifting, straining, or vigorous activity for 3 weeks after surgery. Such activities could dislodge your new eardrum. Do not swim until your doctor tells you that you can. You can often return to work 1 to 2 weeks after surgery, but ask your doctor first.

Diet

You may eat your regular diet after surgery, as long as your stomach is not upset from the anesthesia. If it is, wait until you feel better before you start eating solid foods.

Pain

Pain is usually mild to moderate for the first 24 – 48 hours. Then it will decrease. You may not need strong narcotic medicine. The sooner you reduce your narcotic pain medication use, the faster you will recover. As your pain lessens, try using extra-strength acetaminophen (Tylenol) instead of your narcotic medication. It is best to reduce your pain to a level that you can manage, rather than to get rid of the pain completely. Please start at a lower of narcotic pain medicine, and increase the dose only if the pain remains uncontrolled. Decrease the dose if the side effects are too severe.

Do not drive, operate dangerous machinery, or do anything dangerous if you are taking narcotic pain medication (examples are oxycodone, hydrocodone, and morphine,) These drugs affect your reflexes and responses, just like alcohol.

When to call the doctor?

• 1. Any concerns. We would much rather you call your doctor then worry at home or get into trouble.
• 2. Fever over 101.5 degrees F. that does not go away
• 3. A large amount of bleeding from your ear or from your incision.
• 4. Headaches.
• 5. Leakage of a lot of clear fluid from your nose or ear canal.
• 6. Severe dizziness.
• 7. Weakness of your facial muscles.
• 8. Excessive swelling of the incision behind your ear.
• 9. Redness or warmth around your incision.
• 10. Foul-smelling discharge from the ear or from the incision.
• 11. Pain that continues to increase instead of decrease.
• 12. Problems urinating.
• 13. Chest pain or problems breathing. Don’t call ahead—go to the emergency room right away.

Postoperative follow up

You will need to have your ear canal cleaned out at your postoperative visit in 2-3 weeks after surgery.

Resources

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Source: Data courtesy of the U.S. National Library of Medicine. Since the data might have changed, please query MeSH on Tympanomastoidectomy for any updates.

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